Primary care physicians' perspectives on computer-based health risk assessment tools for chronic diseases: a mixed methods study.

Teja Voruganti,John R Mclaughlin,Mary Ann O'Brien,Eva Grunfeld,Sharon E Straus

doi:10.14236/jhi.v22i3.153

Abstract

Health risk assessment tools compute an individual's risk of developing a disease. Routine use of such tools by primary care physicians (PCPs) is potentially useful in chronic disease prevention. We sought physicians' awareness and perceptions of the usefulness, usability and feasibility of performing assessments with computer-based risk assessment tools in primary care settings. Focus groups and usability testing with a computer-based risk assessment tool were conducted with PCPs from both university-affiliated and community-based practices. Analysis was derived from grounded theory methodology. PCPs (n = 30) were aware of several risk assessment tools although only select tools were used routinely. The decision to use a tool depended on how use impacted practice workflow and whether the tool had credibility. Participants felt that embedding tools in the electronic medical records (EMRs) system might allow for health information from the medical record to auto-populate into the tool. User comprehension of risk could also be improved with computer-based interfaces that present risk in different formats. In this study, PCPs chose to use certain tools more regularly because of usability and credibility. Despite there being differences in the particular tools a clinical practice used, there was general appreciation for the usefulness of tools for different clinical situations. Participants characterised particular features of an ideal tool, feeling strongly that embedding risk assessment tools in the EMR would maximise accessibility and use of the tool for chronic disease management. However, appropriate practice workflow integration and features that facilitate patient understanding at point-of-care are also essential.

Highlights

Health risk assessment tools compute an individual’s risk of developing a disease
Using predictive models based on epidemiological data, health risk assessment tools compute risk of developing a disease, and the resulting risk estimate is conveyed in numerical, text or visual formats.[3,4]
We found that participants in our sample perform risk assessments often, and are familiar with some risk assessment tools including computer-based programs

Summary

Introduction

Health risk assessment tools compute an individual’s risk of developing a disease Routine use of such tools by primary care physicians (PCPs) is potentially useful in chronic disease prevention. A major component of primary care practice is the identification and counselling of individuals at increased risk of chronic disease.[1] Assessing and monitoring risk may be facilitated by various strategies including use of health risk assessment tools.[2] Using predictive models based on epidemiological data, health risk assessment tools compute risk of developing a disease, and the resulting risk estimate is conveyed in numerical, text or visual formats.[3,4] These estimates are used in a wide variety of contexts and for purposes including behaviour counselling,[5,6] screening for health issues[7,8,9] and decision making.[10,11] The advantage of using these tools is that the computed risk information is individualised with a patient’s own risk factors, thereby making such information more meaningful. To leverage patient health information available in the medical record, some electronic medical record (EMR) systems have begun to incorporate risk assessment tools either within the EMR or link to external websites with risk assessment tools.[12,13,14]

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Methods

Discussion

Conclusion